Brief Answer: Please follow my advice as given below Detailed Answer: Hi Ma'am, As mentioned earlier, thorough physical and neurological examination is the MOST IMPORTANT part in evaluating a patient's condition. Unfortunately, I can't examine you, sitting so far away. Hence have to base my opinion PURELY on the information that you provide. However, you have not mentioned if you still have episodes of feeling 'momentary unbalanced'. After reviewing the entire correspondence, there are only three short-listed possibilities:- * Momentary compression (with consequent, momentary disruption of blood supply to internal ear, brainstem and cerebellum) of either vertebra-basilar or, basilar artery, by neck vertebra; or, narrowing of one of these arteries. You had mentioned that momentary imbalance is precipitated by rotating the head. An MRI angiogram of vertebra-basilar/basilar artery will detect if there is obstruction to blood circulation in these arteries. * Basilar migraine - which too presents exactly the way it happened with you. * Vitamin B12 deficiency. I once again recommend that you start immediately, with treatment of anxiety-depression. The SAME treatment is also the IDEAL preventive treatment of basilar migraine. XANAX ALONE, WILL NOT GIVE YOU RELIEF FROM EITHER OF THE CONDITIONS. Also, start taking Vitamin B12 (1500 micrograms) daily, empty stomach. AND, CONTINUE WITH BETAHISTINE orally. Lastly, I was deeply hurt by the rating and your comment. I had NEVER claimed that you had a stroke: I had simply said that it is STONG POSSIBILITY and also that this doubt should be removed. Stroke is either, FULLY REVERSIBLE (called recurrent brain ischemia- as in case of intermittent, momentary disruption of blood supply by vertebra-basilar artery. NO LESIONS ARE SEEN ON MRI); or, PARTIALLY REVERSIBLE/IRREVERSIBLE with permanent brain damage (which is clearly seen in MRI.) Your doctor- who has followed up your case and had carried out clinical, physical and neurological examination- is the BEST JUDGE. I will be happy to answer further queries, if any. Fond regards, Dr. Rakesh Karanwal

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Brief Answer: Common causes ruled out: consider other causes Detailed Answer: Hi Ma'am, I think you have uploaded the same report six times, due to sheer oversight. Anyways, except for mildly raised globulin levels, other values are normal. In view of the new information provided, regarding 'swaying sensation' on sitting or while putting on your shoes (perhaps bending down while putting on shoes) and weight loss, kindly let me know if you also have the following symptoms:- # increased/reduced sweating # Rapid heart rate even at rest # Momentary dizziness on standing abruptly from lying/sitting position? # indigestion, heartburn, diarrhea/constipation # Difficulty in passing urine or have frequent urge to pass urine, or feel that you have not emptied your bladder completely # Do you get frequent attacks of headaches, lasting for hours, particularly after an episode of 'unsteadiness' or 'swaying'? Patent basilar arteries excludes their narrowing due to cholesterol deposition. Now, the possible causes narrow down to * momentary compression of the vertebra-basilar arteries due to change in neck's position. (called Vertebro-Basilar Insufficiency- VBI). Vertebral arteries (which join together to form Basilar artery) pass through narrow openings in the neck bones. At times, narrowing of these openings takes place and thereby, obstructing blood flow. A change in the head position, such as, neck rotation, bending of neck in different directions, cause momentary kinking of the artery --> disruption of blood supply to internal ear, brainstem and cerebellum and thereby cause momentary imbalance. I have seen numerous cases of VBI in my clinical practice; or, * a severe Vitamin B12 deficiency. Blood Vitamin B12 level rules out/ diagnosis this condition. Headaches following a spell of unsteady sensation goes in favor of Basilar migraine. * Further, if you have some/most of the symptoms listed above, the possibility of AUTONOMIC NEUROPATHY needs to actively considered. Please request your doctor to take your blood pressure in sitting and standing position. If there is a marked fall in upper pressure on standing up, this possibility becomes very strong. Also, possibility of an uncommon condition called "Localized Demyelinating Disease" (particularly in view of raised globulin level) may be considered. Please discuss the above-mentioned possibilities with your neurologist on Monday, without naming me. I am very curious to follow your unusual case to its logical conclusion. Please do update me after your neurologist's visit. Lastly, the incident is now a closed chapter. I full understand that you have been through immense mental stress and worry. Have a nice day Dr. Rakesh Karanwal

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Brief Answer: Queries to be asked from doctor are given below Detailed Answer: Well, Ma'am, You probably forgot to upload MRI report due to oversight. Patent artery means that there is NO clogging inside the artery. Hence, the possibility is that the artery gets pinched due to pressure on it from outside. This stops blood flow and blood supply to cerebellum, brainstem and internal ear for a second or so, thereby causing swaying feeling. A nerve has a protective covering called myelin sheath. When the immune system of the body develops a defect, this myelin sheath gets destroyed in patches. This causes the nerve to stop functioning. When the myelin sheath of sensory nerves (that is, those nerves which convey sensory message, such as sense of touch, taste, heat, cold, body's position etc to the brain) is destroyed, the nerve fails to convey the sense to the brain, which is then unable to comprehend the sense. When the nerve- which conveys inputs about the position of the body (such as standing/sitting/lying/bending positions) to the Cerebellum- is affected, cerebellum fails to maintain the balance. The disease in which the myelin sheath is destroyed, is called DEMYELINATING DISEASE, which is due to defect in the immune system of the body. By the way, you have provided a valuable new information. Does the swaying sensation while sitting/standing, increases when you close your eyes? If it does aggravate with eyes closed, then the defect is in the sensory nerves. in that case, an MRI of the spine will reveal the defect. If the swaying sensation does NOT increases with closed eyes, but the swaying feeling increases when STANDING with eyes open, the defect lies in an area of the cerebellum, called vermis. Please discuss the following with your doctor? 1. Is there a possibility of momentary pinching of vertebral arteries due to neck movements as the cause of your swaying feeling? 2. Can it be the first sign of a disease of defective immune system? 3. Can it be due to long-standing, severe deficiency of Vitamin B12 ? 4. Will an MRI of neck and thorax spine reveal an auto-immune disease (disease of defective immune system) or damage to sensory nerves? 5. Please DO NOT FORGET TO TELL THE NEUROLOGIST about swaying feeling while sitting and standing with eyes open. If you find the doctor in a receptive mood, you may kindly discuss my opinion with him diplomatically. Lastly, MAY I ASSURE YOU THAT I AM SIMPLY DISCUSSING THE LESS POSSIBLE CAUSES and am NOT trying to scare you. So, PLEASE RELAX and stop worrying, Ma'am. Have faith in the Lord : All will be well. If possible, please do inform me the outcome of your discussion with neurologist. Wish you a speedy recovery, Dr. Rakesh Karanwal

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Brief Answer: Neurologist should throw some light on possibility Detailed Answer: Hi Ma'am, A NORMAL MRI report should be a matter of great relief to you. It is too premature to jump to conclusions at this stage. I have been doing some loud thinking: THAT'S ALL. An EARLY stage of MS or Sub acute/ Chronic Inflammatory Demyelinating Polyradiculopathy (CIDP) are just some of the remote possibilities. You can ask the doctor about these remote possibilities too. I also agree with your doctors that dizziness is something which is hard to diagnose, as there are numerous causes which cause dizziness. An Epstein Barr infection is known to be associated with MS in only SOME patients. However, it is a question of another 24 hours before you meet the Neurologist; I would be eagerly awaiting his opinion. During neurological examination, he may come across some sign which may be of help to me too. In your next query after visiting the neurologist, please do NOT FORGET to mention whether the swaying sensation while sitting/standing, increases when you close your eyes? Or, whether the swaying sensation does NOT increases with closed eyes, but the swaying feeling increases when STANDING with eyes open? I wish you all the best and a speedy recovery. Have a relaxing Sunday Dr. Rakesh Karanwal

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